Home Health Care

Find the best home health care for you or a loved one.repisodic's information and resources can help you make a decision that’s right for you.

Home health care helps individuals improve their health, regain independence, and become as self-sufficient as possible.

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Home health care includes a wide range of medical care
and support services provided in a home setting. It is for individuals who are recovering from a
hospital stay and need clinical, nursing, social, or rehabilitation treatment and assistance in
daily activities. Home health care is provided by licensed healthcare professionals
who provide medical treatment or rehabilitation. Professional caregivers may also be involved to attend
to non-medical daily assistance or custodial care. These home aides are usually supplied through a home
health or home care agency.

Home Health Care vs. Non-Medical Home Care (Home Care)

Home health care is often confused with non-medical home health care, more commonly known
as home care.

Home Health Care

Home health care services are medical in nature and assist patients recover after a hospital stay or illness.
These services allow the patient to remain safely at home and avoid unnecessary returns to the hospital.
Care may include wound care, injections, intravenous therapy, or skilled nursing. This care is provided
by registered nurses (RNs), licensed practical nurses (LPN’s), physical therapists (PTs), occupational
therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs).

Home health care is usually less expensive, more convenient, and just as effective as care you get
in a hospital or skilled nursing facility.

Non-Medical Home Care

Home care services, sometimes referred to as social care or custodial care, are non-medical
in nature and are typically used on an ongoing basis to help aging individuals complete day-to-day tasks
in their own home. These services are provided by non-medical professionals such as caretakers, instead of
nurses or doctors. For terminally ill patients, home care may include hospice or palliative care.

Types of care may include help with bathing, eating, cleaning the home, and preparing meals. These services
help the person to stay at home versus living in a facility. In-home care is often a lower cost solution to
long-term care or assisted living facilities.

How to Select a Home Health Care Agency

There are four main steps to selecting a home health care agency.

1) Understand Your Medical Needs

Meet with a medical professional to make sure that home health care is the best follow up care option for
you or your loved one. Home health care is best for patients who require medical follow-up care but can remain
in the home setting. If the patient has significant medical needs or requires medical equipment that is only
available at a hospital, a skilled nursing facility or inpatient rehabilitation may be a better option. If the
patient has a specific need (home infusion therapy, wound care, etc.), you can narrow down your search by
evaluating home health agencies based on what specialty care they can provide.

2) Verify Your Insurance Coverage

When selecting a home health agency, it’s important to consider your payment options and understand what
your insurance policy will and will not cover. repisodic.com allows you to contact providers to verify whether
or not they accept your insurance.

3) Compare Facilities Based on Quality Measures

After you’ve identified agencies within your insurance network, you can compare them based on quality measures.
Quality measures are strong indicators of the quality and level of care and rehabilitation you will receive through
an agency. Different qualities to compare are how often the home health team began their care in a timely manner,
how often patients got better at walking or moving around, how often patients’ wounds improved or healed after
an operation, and what percent of patients who would definitely recommend this home health agency to friends and
family. repisodic provides these metrics, and more, for each facility and measures them against state and
national averages to help put them in context and make the comparison process easier for you.

4) Talk to the Agency and Staff

You have the right to choose a home health agency that gives you the care and services you need. Your choice
should be honored by your doctor, hospital discharge planner, or other referring agency. Ask the agency how
different situations are handled and how the patient care plan and needs will be addressed with their services.

Checklist of Things to Consider

Medicare.gov has a list of suggested things to consider when selecting a home health care agency.

How to Pay for Home Health Care

Insurance coverage and network participation are two of the most important factors to consider when choosing a
home health agency. Because home health care is medical care, it is covered by health insurance, including Medicare,
Medicaid, and private insurers. A patient’s individual insurance policy determines what specific home health and
home care services are covered and paid for.

Home Care and Other Non-Medical Assisted Living Services

In general, non-medical home care services are NOT covered by Medicare or other private insurance programs.
Although there are many misconceptions around Medicare’s benefits for home care, Medicare does not pay for
non-medical care at all. It’s safe to assume that in almost all cases assistance for non-medical care provided
in the home is not covered by insurance programs.

Medicaid, an insurance program for low income persons, will pay for non-medical home care, home health care,
and other in-home supports to help individuals remain living in their homes. However, because Medicaid rules
are state-specific, the coverage and eligibility will vary by location. Refer to your local Medicaid office
if you think you or yourself qualifies for Medicaid home care.

Medicare Home Health Care Insurance Coverage

Home health care, when considered medically necessary, is covered at least in part, by Medicare and other
health insurance programs. All people with Medicare Part A and/or Part B who meet all of these conditions are covered:

You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.

You must need, and a doctor must certify that you need either: Intermittent skilled nursing care (other than just drawing blood)
OR Physical therapy, speech-language pathology, or continued occupational therapy services.

The home health agency caring for you must be Medicare-certified.

You must be homebound, and a doctor must certify that you’re homebound.

These plans vary widely in their coverage and policies for home health care. The majority of plans typically
provide some sort of coverage for medically necessary home health care, similar to Medicare coverage policies.
Private insurance companies will typically only pay for home health care services for providers that are
considered “in-network.” Some policies will cover services from providers that are “out-of-network”, but they
usually do not cover as much of the cost and can leave patients with additional out-of-pocket costs. That’s
why it’s so important for patients to check if a home health agency is part of their insurance network.

To Summarize

Health insurance payment options and programs that cover home health care services are quite complex and regularly
subject to change. A patient’s individual insurance policy determines what post-acute care services are covered
and paid for. repisodic encourages all patients to consult with their insurance company or administrator for
final determination of what post-acute care or home health care their policy covers.